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The Somatic Connection  |   April 2013
Yoga for Chronic Neck Pain: A 12-Month Follow-Up
Author Affiliations
  • Michael A. Seffinger, DO
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
  • Vanessa Mervyn-Cohen, OMS III
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California
Article Information
The Somatic Connection   |   April 2013
Yoga for Chronic Neck Pain: A 12-Month Follow-Up
The Journal of the American Osteopathic Association, April 2013, Vol. 113, 355-357. doi:10.7556/jaoa.2013.113.4.355
The Journal of the American Osteopathic Association, April 2013, Vol. 113, 355-357. doi:10.7556/jaoa.2013.113.4.355
Cramer H, Lauche R, Hohmann C, Langhorst J, Dobos G. Yoga for chronic neck pain: a 12-month follow-up [published online ahead of print February 6, 2013]. Pain Medicine. doi:10.1111/pme.12053.  
Between 50% and 70% of individuals have neck or shoulder pain at least once in their lives.1,2 According to some sources, neck pain is one of the most common reasons that complementary and alternative medicine is pursued. The current understanding is that individuals who are healthy and have a physically active lifestyle are less likely to have chronic pain, but little information exists regarding the type of therapy that might provide moderate mobilization for someone who is in pain. Yoga, a form of complementary and alternative medicine therapy and exercise that has roots in ancient Indian spiritual practices, has been thought to help control chronic pain. According to a study published in 2004, 20% of yoga practitioners use yoga techniques for control of spinal pain.3 
Researchers from the Department of Internal and Integrative Medicine at the University of Duisburg-Essen in Essen, Germany, conducted a randomized controlled trial in which the effects of a 9-week yoga intervention for alleviation of chronic nonspecific neck pain were assessed.4 The researchers found that patients assigned to a yoga group had improvements in pain, functional disability, and mental quality of life, compared with patients assigned to a control group.4 In this study, the results of a 12-month follow-up of data from the aforementioned study of Iyengar yoga are reported. 
Patients for the original study were recruited through a local newspaper. Participants were aged between 18 and 60 years, had nonspecific neck pain for at least 5 days per week during the past 3 months, and had a mean neck pain intensity of at least 40 mm on a 100-mm visual analog scale (with 0 mm denoting no pain and 100 mm denoting the worst pain imaginable). Exclusion criteria included psychiatric problems, addiction, a specific diagnosis of neck pain, active oncologic disease, inflammatory rheumatic disease, pregnancy, disability precluding yoga practice, invasive spinal treatment performed within the past 4 weeks, spinal surgery performed during the previous 12 months, and yoga practiced during the previous 12 weeks. 
In this 2-arm, randomized controlled clinical trial with long-term follow-up, participants were randomly assigned to a yoga group or a control group after completing the first baseline assessment session. The control group was provided with a self-care exercise manual designed by a large statutory German health insurance company. One week later, the yoga group started their 9-week yoga intervention. The Iyengar style of yoga, known for its accessibility, focus on precise alignment, and use of props to prevent straining and achieve perfect alignment, was used in the intervention.4 The 9-week program was taught by a certified Iyengar yoga instructor who received assistance from an individual with a master's degree in psychology who specialized in working with patients with chronic pain. Participants in the yoga group practiced Iyengar yoga in weekly 90-minute sessions, and they were also asked to practice at home for 10 minutes each day. When the intervention was complete, both the yoga group and the control group were reassessed. The control group then began its own 9-week yoga intervention. Twelve months after completion of the yoga intervention, both study groups participated in a final assessment. 
The outcomes that were measured included neck-related disability (assessed by the neck disability index [NDI], with sum scores ranging from 0 to 100, and with higher values indicating greater disability), health-related quality of life (assessed by the Short-Form 36 Health Survey questionnaire, which evaluates both the general mental and general physical state), overall improvement (assessed on a basic 5-point scale), and intervention adherence (based on the number of minutes that yoga was practiced during the past month). Binary logistic regression analysis was performed to assess possible predictors for obtaining clinically important (30%) reductions or clinically substantial (50%) reductions in pain intensity. Included in the regression analysis were the number of yoga courses attended, regular yoga practice during the past 12 months, and the number of minutes practiced weekly during the past 4 weeks. 
Of the 51 participants in the original study, 36 completed 12-month follow-up. From baseline to the 12-month follow-up, the mean (standard deviation [SD]) changes noted were as follows: pain intensity improved from 48.81 (17.71) mm to 32.31 (20.68) mm (P>.001), the NDI decreased from 25.26 (9.02) to 19.49 (11.52) (P=.001), and bodily pain improved from 49.37 (12.40) to 59.26 (17.57) (P=.005). Improvements in pain intensity were predicted on the basis of the number of minutes that yoga was practiced each week during the past 4 weeks (r2=0.12; P=.028), and improvements in neck-related disability (r2=0.24; P=.001) and bodily pain (r2=0.26; P=.006) were predicted by regular yoga practice during the past 12 months. Generic disability did not decrease significantly. Twenty-four patients (68.6%) considered their health to be at least somewhat improved. 
Although this study indicates that patients had reduced neck pain and decreased disability for at least 12 months after completion of the yoga intervention, improvement in pain intensity was correlated with continued practice of yoga. Continuing to practice yoga therefore seems to be the most accurate predictor of long-term efficacy and relief from pain. Two limitations of the present study are that it comprised mostly well-educated women and that it was small in size, which may limit the generalizability of its findings to the entire population of patients with chronic neck pain. 
References
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Mäkelä M, Heiliövara M, Sievers K, Impivaara O, Knekt P, Aromaa A. Prevalence, determinants and consequences of chronic neck pain in Finland. Am J Epidemiol. 1991;134(11):1356-1367. [PubMed]
Saper RB, Eisenberg DM, Davis RB, Culpepper L, Phillips RS. Prevalence and patterns of adult yoga use in the United States: results of a national survey. Altern Ther Health Med. 2004;10(2):44-49. [PubMed]
Cramer H, Lauche R, Hohmann Cet al. Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain. Clin J Pain 2013;29(3):216-223. [CrossRef] [PubMed]